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Prospective evaluation of bladder tumor targeting by Hexvix(®) fluorescence.From September 2008 to April 2012, 107 patients have been evaluated using Hexvix(®) technique (blue light) for typically papillary bladder tumor or suspected bladder tumor. Clinical and pathological data have been collected prospectively and patients have been classified using EORTC score.From the 107 patients, 67 have been identified with bladder cancer and 328 samples have shown positive fluorescence in blue light. Compared to white light, 13 additional tumors have been diagnosed by Hexvix(®) for 11 patients: Cis (n=6), LMP (n=3), pTa low grade (n=3), pT1 low grade (n=1) (P=0.003). The false positive rate for Hexvix(®) was 53.4% versus 52% for white light. Previous TCC history, multifocality and EORTC score for recurrence and progression have been associated with better bladder cancer targeting by Hexvix(®) (P=0.007; P=0.01; P=0.03; P=0.04).In our experience, Hexvix(®) targeting was associated with better diagnosis for bladder cancer with 9% (13/144) of new positive samples (P=0.003). In our study, false positive rate is a critical point (53.4%). Multifocality, previous TCC, and EORTC score for recurrence and progression might allow selecting patients to be targeted by Hexvix(®).

Evaluate epidemiology, diagnosis and outcome of de novo renal cell carcinoma in renal transplanted patients.From June 1989 to December 2007, 824 renal transplantations were carried out and followed in annual consultation by an urologist with abdominal echography or tomodensitometry. The suspect renal lesions were treated by a widened nephrectomy. Incidence, diagnosis, treatment, histological type, and outcome of all patients were analysed.Thirty-three patients had nephrectomy for suspect renal lesions. Twenty-two de novo tumours of native kidneys among 21 patients were diagnosed (15 renal clear cell carcinoma and seven papillary tumours) with mean time after transplantation of 25,6 months (2.3-105.5). All tumours were classified pT1aN0M0. Only one patient died at 8 months of metastatic dissemination of a papillary tumour classified initially pT1aN0M0. All the other patients are alive with mean follow-up of 34.8 months (2.8-113.9). Specific survival to 5 years was 93.3%.The increase risk of tumour at the renal transplanted patient led to propose in the event of suspect lesions of the native kidneys, a widened nephrectomy. In our series, 65% of the operated patients carried a cancer. The good forecast of these localized tumours justifies a regular radiological monitoring and an aggressive therapeutic attitude despite of absence of tumours in 35% of the transplanted patients.

To determine the sensitivity and specificity of MRI to distinguish between superficial and invasive transitional cell bladder cancer.Sixty patients (52 men and eight women) with a mean age of 66.8 years were assessed by bladder MRI between May 2002 and November 2005 for a primary bladder cancer diagnosed by endoscopy, followed by transurethral resection and histological examination of the bladder cancer. Patients presenting a discordance between MRI findings and histological examination were analysed.Imaging and pathology staging was concordant for 49 bladder cancers (40 superficial and nine invasive). Ten tumours considered to be invasive on MRI were superficial on histological examination and six of them relapsed at the resection scar at one or three months. The sensitivity of MRI was 80% for a specificity of 90% and a positive predictive value of 97.5%.MRI is a reliable examination to confirm the superficial nature of bladder cancer. When MRI and histological examination of a bladder cancer resection specimen are discordant, second look surgery is recommended to treat residual disease, which was present in 60% of cases in the present series.

Transitional cell carcinoma of the kidney with caval tumour thrombus is extremely rare. The authors describe the radiological signs suggesting the preoperative diagnosis and guiding the therapeutic approach. They present the case of a 51-year-old patient with excluded caliceal stones, and review 17 cases published over a period of 24 years during which considerable progress has been made in radiological investigations. Only CT appears to be able to indicate this aetiology and allows retrograde ureteropyelography looking for a tumour of the urinary tract. MRI provides the best assessment of tumour involvement of the inferior vena cava. Nephroureterectomy with excision of a perimeatal bladder cuff and cavotomy is the only oncological surgical procedure, despite the extremely poor prognosis.

The authors report a retrospective series of 114 radical prostatectomies performed over a ten-year period. This study was designed to investigate the factors likely to cause complications in order to prevent them. Stenosis of the vesicourethral anastomosis was observed in 22 patients and represented the commonest complication (19.2%). It generally occurred before the 12th month, while late stenoses. An anastomotic leak after removal of the bladder catheter appears to be the most significant factor. The decreasing incidence of these stenoses over the ten-year study period illustrates the role of operator experience. The most effective treatment for these stenoses is mono-incision which, completed by dilatation sessions, prevents recurrence without compromising continence.

The authors report a rare case of bilateral ureteric stenosis associated with necrotic infiltration due to acute alcoholic pancreatitis. The obstruction was caused by bilateral ureteric fibrosis with calcified incrustations on the right side and massive obstructive calculi on the left side. Only one faintly similar case has been reported in the literature out of 17 cases of unilateral or bilateral ureteric stenosis complicating acute or chronic pancreatitis.

The authors report three cases of cystic tumors of the kidney: one benign papillary tumor and two renal cell carcinomas. Although the clinical features were atypical, the authors emphasize the role of computer tomography which make easier the diagnosis of these scarce tumors. When the diagnosis is doubtful a guided needle biopsy is recommended.

The authors study the incidence of urethral strictures after transurethral resection of prostate. A retrospective study of 135 patients and a prospective study of 187 patients found respectively 74% and 3.2% of urethral stenosis. Two important data are seen in this study, the duration of urethral catheter of 24 hours post operatively and the internal urethrotomy when they found a pathologic urethra pre operatively reduce the incidence of urethral strictures. With a normal urethra pre operatively and 24 hours of urethral catheter post operatively, any stenosis occurred, equally when an internal urethrotomy is done with a pathologic urethra pre operatively.

Intra-hepatic cholangiojejunostomy (group I patients) and simple trans-tumoral intubation (group II patients) were retrospectively compared in a series of 44 patients with primary carcinoma of the hepatic duct junction. Hospital mortality was 30% in the 13 group I patients and 9.5% in the 21 group II patients. Jaundice and pruritus were equally relieved in both groups. The mean survival time (hospital deaths excluded) was 16 months in group I and 12 months in group II patients. It is concluded that the decision as to which of these two palliative surgical procedures should be performed must rest on the degree of biliary duct distension as well as on the patient's age and general condition.

The authors study the incidence of urethral strictures after transvesical prostatectomy. A retrospective study of 90 patients and a prospective study of 78 patients found respectively 2% and 0% of urethral stenosis. The important data of this study is the duration of urethral catheter post operatively.

The authors report three cases of leiomyosarcomas of the small intestine and review the literature on this subject. Leiomyosarcomas of the small intestine are rare tumours, representing 0.2% of all malignant tumours of the gastrointestinal tract. These large, round, hypervascular tumours are derived from smooth muscle cells in the intestinal wall and often develop extra-luminally. The malignant nature is often difficult to confirm on the histological examination. The clinical signs often only appear when the tumour has reached a large volume. It is rare to make the diagnosis pre-operatively, despite the use of a number of investigations. Arteriography is the most reliable examination. Spread of the disease is essentially haematogenous. The malignant tumour invades adjacent organs, causes hepatic metastases and peritoneal seedlings and tends to recur locally. The treatment is essentially surgical and the prognosis varies according to the size of the tumour, its grade, its activity and its degree of extension. The 5-year survival of all forms of the disease varies between 20 and 50%, according to the series.

The review of the literature and our study of 15 tumors in bladder diverticula (IDT) show us that these tumors are rare and mainly observed in elderly adult males. Bleeding is the major symptom. Diagnosis is difficult and treatment is not well defined. Prognosis is good for low stage tumors and catastrophic in the short term for high stage tumors. Nearly half of IDT were primary tumors, and one third of them stay primary until death of the patients. Most of the high stage tumors contained a squamous cell differentiation and all the tumors with these features were deeply invasive. The bad prognosis is mainly related to the difficult and delayed diagnosis, with a long symptomatic period, regardless of treatment. This emphasizes the need for further investigations (biopsies, sonography, computer tomography) when the diagnosis is not evident. The treatment of these tumors depends on the general status of patients and the volume and stage of tumors. Low stage tumors (Ta) and diverticula could be treated either by transurethral resection or by open surgery with good results. In (T1) tumors, only open surgery is recommended to avoid loco-regional relapse. High stage tumors (greater than or equal to P T3) were treated by either TUR or open palliative surgery with the same bad prognosis. No radical treatment was indicated since patients have a bad performance status and most of the tumors extended beyond the diverticulum. Adjuvant treatments were not helpful. While preventive diverticulectomy is to be discussed case by case, we think that an important step in improving the prognosis of these tumors is to make the diagnosis at an earlier stage.